A Messy Miracle for the ER

In a miracle of resuscitation, the state Legislature on Saturday approved a new way to pay for California’s ailing emergency-care system. How it happened was messy, but the outcome is hard to fault.

Senate Bill 807, which now awaits Gov. Gray Davis’ signature, would help pay for emergency care by adding a $200 surcharge to fines for reckless driving, speeding and drunk driving. It’s almost a user fee, since so many of these folks end up needing trauma care.

The money raised--projected at $25 million--wouldn’t cure the state’s health-care woes; neither would it lift the pressure from Los Angeles County. But it would prop up the system facing the most immediate crisis, the one that all of us count on in the event of an accident injury or a heart attack.

Hospital emergency departments and the more specialized trauma centers are overwhelmed and underfunded. Required by law to see anyone who needs care, regardless of ability to pay, emergency rooms in California struggle to stay open in the face of inadequate managed-care payments, pitifully low Medi-Cal reimbursements and 7 million residents with no insurance at all, public or private. Many don’t succeed. In the last decade, more than 50 emergency rooms and 17 trauma centers have closed statewide.

The ones that remain open shoulder ever-larger loads, leading to backlogs and long waits. Searching for a new source of funding, the state association of emergency physicians and other medical groups floated the idea of a “sin tax” on serious traffic violations. A portion of current fines already goes to emergency care, but costs have long outpaced the money in the fund the Legislature established in 1987.

Piecing together SB 807 was as rushed and makeshift as any MASH operation. Using what in Sacramento-speak is called “gut and amend,” Sens. Joe Dunn (D-Santa Ana) and Don Perata (D-Alameda) deleted the original content of an unrelated bill and replaced it with completely new language.

The Legislature already had included in its budget a separate $25 million solely for trauma centers. This and SB 807 would help keep private emergency departments and physicians as part of the health-care safety net, making up for some of the $325 million they reported losing in 2000.

There would be little left, however, to help Los Angeles County-run hospitals. That problem will require Davis’ involvement and leadership, starting with not rolling back payments to Medi-Cal--the state’s version of Medicaid--as he originally proposed. In the meantime, he should sign SB 807. It is a start on what he needs to do.